Naval Health Clinic AnnapolisPresentation to the

Parent Club Officer Conference

12 September 2019

Overview of Topics

• History of Healthcare at USNA

• Medical Services

• Brigade Evolution Support

• Dental Services

• Health Plan and Customer Experience

Supporting the Brigade Since 1845

It became apparent shortly after the Naval Academy officially opened in 1845 that separate arrangements needed to be made for sick midshipmen. The first hospital was a four-room wooden building constructed on the parade grounds in 1846.

The second hospital was completed in 1853 in the vicinity of the present Officer's Club. It was a brick three-story building with wards, a small dispensary, quarters for the medical staff, and a kitchen. It was abandoned with the rest of the Academy grounds during the Civil War between 1861 and 1865. It resumed use as a hospital in 1865 and continued use as a dispensary after the third hospital was built.

After the Civil War, the third hospital was built in the shape of an anchor in the vicinity of Perry Circle.

It was used only 1871-1876 and then abandoned because of high malaria transmission to both patients and staff due to the close proximity to the river. The second hospital was then renovated and returned to use.

The fourth hospital was commissioned in 1901 and opened in 1907 on “Hospital Point.”

It was subsequently expanded several times. Functioned as a hospital for 72 years until 1979, when the scope was reduced to outpatient services only.

In 2009, NHCA assumed control of NBHCs Earle, Lakehurst, Mechanicsburg, & Philadelphia.

Navy Medicine had a presence in USNA Bancroft Hall since the first two wings were completed in 1906.

In 2002, a new Brigade Medical Clinic opened in Bancroft Hall . The renovated facility included primary care, dental, orthopedic, and optometric services for the Brigade of Midshipmen.

1846-1853 1871-1876 1907-2017 2002 - Present1853-1907

The historic Hospital Point was relocated to a brand new, state-of-the-art $43.5M facility and opened for the first time on March 28, 2017.

The new location is conveniently located near the NEX, FFSC, MWR, and Commissary. Services were expanded to include Dental and Musculoskeletal Clinics.

2017 - Present

NHCA Beneficiaries

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• Total Enrollment: 14,442

- 3,660 Active Duty

- 2,755 Active Duty Family

- 3,042 Retirees & Family

- 4,965 Midshipmen (MIDN)

Six Clinics Across Three States

A – North Severn / NBHC Bancroft HallB – NBHC Earle (191 miles)C – NBHC Lakehurst (186 miles)D – NBHC Mechanicsburg (113 miles)E – NBHC Philadelphia (118 miles)

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Medical Services Within Bancroft• Staff: 71 Active Duty and 22 Civilians• 6th and 8th Wings• Clinical Services:

o Primary Careo Dentalo Optometryo Behavioral Healtho Comprehensive Concussion Clinico Orthopedic Surgeryo Physical Therapyo Podiatryo Sports Medicine and PM&Ro Travel Medicine / Immunizationso Flight Medicineo Undersea Medicine

• Clinical Support Serviceso Pharmacy, Laboratory, Radiology

Brigade Medicaland Dental Operations

• 8th Wing Ground Floor

o Musculoskeletal Sick Call

• M-F Sick Call 0630

o Physical Therapy

• M-Th 0630-1500

• F 0630-1100, 1200-1500

o Optometry

• M-F 0630 - 1500

o Concussion Clinic

• M-F 0730 - 1600

• 6th Wing Ground Floor

o BMU & Ancillary Support Services (Lab, x-ray, Pharmacy)

• M-F 0630 to 1800

• Weekend Sick Call 0700-0900

o Musculoskeletal (Ortho/Sports/Podiatry)

• M-F 0630-1500

• Dental (operations covered later in the brief)

Duty Health Care Provider (DHCP)Answering Service

• Self-care advice

• After hours and when out of town (leave or travel)

• Authorization to go to a TriCare approved Urgent Care

• NO authorization required to any Emergency Dept. for emergencies

Urgent Care andEmergency Department

• Based on medical issue and time of day

• Right Time or Patient First are our closest local TriCare-authorized Urgent Care

• Walter Reed Military Medical Center

• Anne Arundel Medical Center

Relay Health – Secure Messaging

• Web-based communication between MIDN and Medical Staff

• Benefits:

o Secure

o Med refills, test results, request non-urgent appointments

o Ask questions to providers

o Protects health information

o Usable after USNA

Self-Care Guide On the USNA Intranet

Over-the-Counter Medication Program

Year-Round Medical Support of the Brigade

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Plebes Youngsters Second Class Firsties

Induction Day Summer training Screenings COMMISSIONING PHYSICALS

SERVICE SELECTION PHYSICALS

Confidence Course Yard Patrol Ops Leatherneck SWO Screening

Obstacle and Endurance Course

National Outdoor Leadership School (NOLS)

Screening

SEAL Screener Color Parade

Herndon Climb Philmont Scouts ScreeningExplosive Ordinance

Disposal and Sub ScreenerGraduation

Sea Trials Surface Cruise Screening Marine Special Opportunities Training (MARSCOT) Screener

Weapons Range Protramid Screening Powered Flight Screening

Year-long Evolution Support: 1,883 man hours (by clinic staff members)Ex. Summer training medical screens (1,800 encounters)

Noteworthy Projects• Footwear (collaboration with USNA and WRNMMC)

o Podiatrists onsite to scan each incoming Plebe’s feet at footwear issuance

o Semi-custom orthotics created on the spot

o Referrals provided for outliers with propensity for injury

o Footwear vendor change to incorporate arch and other foot feature differences

• Healtho Innovation – secure messaging, telehealth, visiting providers

o Sick call fast track; working on privacy reconfiguration

o Over the counter program – waiver granted for Brigade

o Travel Clinic for staff and students

o Disease surveillance – imms screen, infection control, electronic syndromic monitoring (ESSENCE)

o Adenovirus Immunization

• Collaborative Partnershipso USNA Parents Club, Faculty Senate, Spouses Club, AAMC ERSA, MIDN Advisory Council

o Developed Tele-Medicine – 7 product lines and $1M in Virtual Health funding

o Resource sharing and currency building through simulation, USNA, NCR, and community partners

o Ray Chronister Sports Med Career Development Program

Concussion Screening and “State of the Art” Management

• Baseline (Plebe summer) Neurocognitive Assessment using ANAM

(Automated Neuropsychological Assessment Metrics)

• Care for 150-200 concussions per year

• Available resources for concussion education for staff and faculty

• NCAA-DoD Concussion Study to help better prevent injury

• Cross-Academy integrated approach to recovery (Academics,

Brigade and PE/Sports) established:

o “Return to Learn” and “Return to Play” Protocols

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Sports Medicine• Sports Team Coverage:

o 1200 Varsity Athletes

o 14 Team Physicians and 1 Sports Psychologist

o 33 Varsity NCAA Division 1 sports teams

o 14 Club sports teams

o 2,664 man hours (by medical providers)

o 2 training room evening clinics M-T 1730-1900.

Athletic Training Rooms provide the genesis for initiatives that benefit All Midshipmen:

✓Vitamin D Initiative

✓Concussion Initiative

✓Foot Care and Orthotic Initiative

✓Sideline Emergency Response Training

USNA Admissions

• Medical Officer assigned to USNA Admissions Office

• Provides a waiver recommendation to the USNA Superintendent

• Some applicant health conditions that may not be compatible with Commissioning

o 631 applicant records screened before

I-Day for the class of 2023

o MIDN Candidates required 164

specialty consultations on I-Day before

they could take the MIDN Oath

o 16 Plebes required Superintendent

waiver on I-Day screenings

Patient Privacy Legalities• We have a patient privacy relationship with your MIDN

• HIPAA legal statutes prevent sharing of MIDN information without written consent

or their presence for us to discuss their medical care

• Information may be shared with the MIDN Chain of Command on a limited bases

Patient Safety Legalities

• For safety and legal considerations, do not give your MIDN medication

prescriptions that were not provided through Brigade Medical or Tricare

• Urine Drug Screens randomly performed on all military members to include MIDN

• MIDN MUST receive medical counseling and approval for outside surgery

Brigade Dental – Birthplace of Navy Dentistry

Brigade Dental Clinic

• Located in the basement of 6th Wing Bancroft Hall

• Hours: Monday-Friday 0645-1545

• 24 hour duty section for dental emergencies

• Dental sick call hours:

o Monday-Friday 0800-1000

o Monday-Thursday 1300-1400

• Appointments are made via email, phone, or in person

Dental Treatment

• Diagnosis

o Annual exams

• Screening: oral cancer screenings, TMJ, decay, gum health

o Sick call

• Restorative

o Replace decayed and missing tooth structure

• Tooth colored composite, ceramics, gold, etc…

• Preventive

o Dental hygiene (teeth cleanings)

o Sealants and fluoride treatment

o Mouthguards

Dental Specialty Care

• Periodontics

o Dental Implants

o Treatment for periodontal

disease

o Soft tissue (gum) grafting

• Oral surgery

o Tooth extractionso Biopsieso Orthognathic (jaw) surgeryo IV sedation

• Prosthodontics

o Crown and Bridge

o CEREC restorations

o Implant restorations

• Orthodontics

o Braces

o Coordinate for orthognathic (jaw) surgery

o Adjunctive treatment with other specialties

State-of-the-Art Technology• CEREC – Single appointment Crowns

• Complete Dental Laboratory

• Ceramics (crowns, veneers, onlays)

• Implants

• Laser

Health Plan and Customer Experience

Midshipmen Have Access To:

• Brigade Medical Unit (BMU) 24/7 coverage

• 7 days per week of sick-call

• Nurse Advise Line: 1-800-874-2273

• Patient Portal Secure Messaging communication

• Vision Care

• State-of-the-art Dental care management

• Care coordination and case management

• Orthopedic surgical cases performed at Anne Arundel Medical Center

• Immunizations

• Pharmacy

WHAT IS TRICARE?

• Department of Defense’s integrated health care delivery system

• The program is designed to provide health care services to members

associated with the United States Military (Midshipmen)

• Your son or daughter, are considered Active Duty members and pay no out

of pocket expenses for care. No enrollment fee, no deductible, no cost-

share

• TRICARE PRIME (Midshipmen) must seek care from the Military

Treatment Facility (MTF) when it’s available

• If the medical service is not available at the MTF within the appropriate

access standards, they will be deferred out to a TRICARE network provider

TRICARE Quick Notes

• Urgent Care outside of the Military Healthcare System (MHS) requires a

referral.

• Emergent Care, does not require a referral, however, we ask that your son or

daughter contact BMU within 24 hours.

• TRICARE Enrollment – Humana TRICARE East Contractor: 1-800-444-5445

• Your son or daughter are currently assigned to the Brigade Medical Unit

(BMU) (410) 293-1758

• They have a Primary Care Manager (Doctor) assigned to them

• They must get a referral from their Primary Care Manager for subspecialty care

• Uniformed Services Identification Cards / CAC Cards

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TRICARE Quick Notes

• TRICARE Exclusions, cosmetic surgery, gym membership, hair removal,

massage therapy, megavitamins,

• TRICARE is the only coverage. It will pay first even if they have OHI.

• Active Duty Dental Care United Concordia 1-899-984-2337

• Need assistance with a claim or have TRICARE questions, contact our

Health Benefits Advisor at (410) 293-2276 or email.

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• Direct Care Workload:

o Medical Patient Encounters (physicians, PAs and IDCs): 33Ko Dental Patient Encounters: 17Ko Dental Procedures: 39K

• 6,650 dental exams• 3,129 dental cleanings

• Surgical Caseload (Orthopedics and Podiatry):o Surgical cases: 221

• Clinical Support Services Workload:

o Laboratory Services: 24K (specimens processed) o Radiology Services: 5K (images taken)o Pharmacy Services: 30K (prescriptions filled)

• PRK/LASIK procedures:

o 347 procedures completed (co-managed by Optometry)

Workload and Productivity

• Access to Care

o 24 Hours Appointment Availability: 0.56 days (1 day or less is MHS target)

• This is for scheduled appointments, walk-in patients are seen/evaluated more quickly

o Future Appointment Availability: 1.85 days (7 days or less is MHS target)

• Referral Management

o NHCA Specialty services (Ortho/Sports Med, Mental Health) will process referrals

and evaluate patients in <1 day for acute/urgent issues (MHS target is 2 days for

referral to booking alone, and 18 days for referral to appointment timeframe)

BMU Clinic Performance Metrics

Satisfaction with Care/MIDN Feedback

• How do we capture the “voice of the customer?”

• Sources of feedback (survey and qualitative):

o JOES (Joint Outpatient Experience Survey)

o ICE (Interactive Customer Evaluation)

• Sources of direct/personal feedback:

o MAC (Midshipmen Advisory Council)

o Departmental Customer Relations Representatives

Dedicated to the MIDN I-Day to Commissioning.

We are available over lunch to answer any questions.

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